Background: The burden of cardiovascular disease in North Carolina remains large. The latest data available show an annual cardiovascular death rate of 263 per 100,000 explaining almost one-third of deaths in the state. Disease progression is largely determined by several risk factors including elevated blood pressure or cholesterol, not using aspirin for prevention, and tobacco use. Primary care practices as currently organized have been unable to get more than half these patients to achieve recommended targets for risk factor reduction. Small independent practices, in particular, lack resources for enhanced practice support to improve cardiovascular care. Objective: The objective of FAST PACE NC is to determine if primary care practice support accelerates the dissemination and implementation of PCOR findings to improve heart health and increases primary care practices' capacity to incorporate other PCOR findings in the future. Methods: FAST PACE NC is a stepped wedge, stratified, cluster randomized trial to evaluate the effect of primary care support on evidence-based CVD prevention and organizational change process measures. Each practice will start the trial as a control, receive the intervention at a randomized time point, and then enter a maintenance period 12 months after starting the intervention. 150 high readiness then 150 low Readiness practices will receive facilitation in a staggered manner beginning at project month 7 with the last practices starting at month 16. All practices will receive 12 months of the intense intervention including onsite QI facilitation, academic detailing, EHR support, and, through the North Carolina Health Information Exchange, a shared statewide utility providing whole population analytics, care gap identification, benchmarking, and an external reporting mechanism which otherwise would not be available to independent practices. Potential Impact: A successful intervention would prove that practice facilitation supported by effective informatics tools is an effective method of translating PCOR findings into practice. Discernible reductions in cardiovascular risk in 300 practices covering over an estimated 900,000 adult patients would likely lead to prevention of thousands of cardiovascular events within 10 years.